Week 4: Skinny, Blasto Lesions, Eye Update & Foods

Day 22:

Tonight officially puts us into the start of the 4th week against this crappy thing. Tomorrow we are going to stop by the vet just to weigh Xena (I swear she's put back on at least 1lb ...) The vet called today to check on us and said she talked to the head blasto vet in TN again about Xena and that he recommends a blood panel to be sure shes getting the right amount of the meds into her bloodstream just to be sure she's on the right kind. (There are 2 different types of meds for this and sometimes the generic might not work as well). No big deal, its just $200 bucks and more blood draws for the puppy ... UGH. She does seem a little off today -- not eating as well, more tired -- but it might also be that its the first time she's had her pain meds in a few days too. (Gave it to her so she'd sleep instead of lick her lesions all day while no one was home to watch her).

last night (top) and 20 hrs later (bottom)

In other news, her lesions do look better even after just 1 night of the pascalite clay. She doesn't like when I put it on her, but she's loves to try to lick it off (it's safe for consumption).



















Day 23:  Xena gained 1.5lbs back today!! Then came home and ate enough food for 1.5 days worth of meals. ((Tonight we will just stick with the positives since neither Xena nor myself are happy about somebody leaving to go back to Texas tomorrow)).

protesting him leaving with snuggles

Day 24: Today Xena played! It was short and sweet but it was completely her! When I got home from work I was greeted by puppy howls, mouthing/wrestling and flailing limbs while rolling in the dog bed for 3-4 minutes. Then she came out of the room and went and picked up a toy to play tug with!!! I haven't seen this in a month from her.

breakfast in bed anyone? 

Day 25: Another trip to the vet for a follow up eye appointment. Good news -- Xena has officially gained 2.2 of her 10lbs she's lost! Her eye looks well according to him, she can't see out of it, but it's normalizing in shape, clarity and viscosity. He also did not say the 'R' word at all while we were there -- removal (enucleation). I know that this is not still off the table since Blasto can hide anywhere and the eye socket is not a super great place to get meds into for total recovery, but still .. he never said it. (And he has at every visit prior to our blastomycosis diagnosis). But hey, we gained 2.2 lbs in 10 days AND the eye specialist didn't charge us a penny for our visit today -- whew!




Day 26:

eating kibble -- the stare down for more

skinnnnny girl 

WE FINALLY GOT SOME DOG FOOD SHE WILL EAT!!!

Thanks to City Dog Market in Buckhead, GA for all their help today. Xena actually ate dog food for dinner tonight.

 If you have never been to check them out before, I highly recommend it -- even if it's just for a toy or for a friendly face to pet your puppy. I don't even know if I ever got the girls name, but she was great. Not over the top, shove info in your face about different foods. She asked all the appropriate questions about what my dogs needs where and what she was on before and then opened 3 bags of samples for us to try. Xena ate 2 of the 3 of them no problem and kept asking for more. The 2 she liked were made by Fromm Family . She loved the pork and applesauce as well as the duck and sweet potatoes, so I bought a 5 lb bag of each to just be sure. When we got home she ate a 1/2 cup of each of them. She left 5 pieces of kibble in the bowl of the duck so I offered her the pork one for dinner and she ate another cup of it! This is great. Her body needs some normalcy with it's meals not to mention all of the nutrition that's meant for my 4 legged pup that is in the Fromm kibble.


Day 27:

Today's a day for sleeping for this pup. She's been herself today, just with really long naps in between. She's eating average today too. She ate 1 cup of kibble at 5 am, 1 1/4 cups at 8am, 1/2 cup at 4pm and I'm hoping to get her to eat a little more before bed tonight... but since she's taken the anti fungal meds already not sure how that will go over. She's supposed to be eating 3.5 cups a day of food so we've met that  -- she was eating 4 cups a day before all of this and she was never gaining weight then either (but she also wasn't sleeping like this ...)














Day 28:

What a way to end week 4 -- tonight Xena hung out on the couch and was up and down and playful almost all night during the period that she's normally comatose and asleep during her post-meds meal. She's been on this poison for a month now and it finally seems like it doesn't completely shut her down for the first time tonight.

Week 3: Losing More LBs, Steak & BFFs.

And so begins the 3rd week of this blastomycosis infestation on our puppy....


Day 16:

Today has been an interesting day. This morning Xena would not eat anything. Came home from work at 1pm and we went to our follow up vet appointment. She was running a fever there, has lost 2 more lbs (10 total now) and had blood work done. Her blood work came back already tonight and her liver and kidneys are doing well and there was nothing else (fortunately) out of the norm for her blood work since they know she's fighting off this infection. Got home and she ate 8oz of wet dog food and 1/2 a cup of dog food. Two hours later she ate 1/2 a steak, 1/2lb of carved turkey and a bunch of blue buffalo dog treats (that were hiding her meds). So of course everyday has its ups and downs ... ups of the day is that she's eating well at this moment ...   today's downs... shes's now sneezing blood, which is really kind of difficult to clean up... it's only from 1 nostril, so it's not a GI issue. Means its either a lesion in her nose or just a really irritated nasal passage. Poor girl, she can't catch a break.

clean plate club

joined me on the couch for the first time in 2 weeks

Day 17:

Finally, a day with nothing new popping up. Nose bleeds lessened (hasn't had one tonight), ate a TON for dinner, took all her meds no problem. AND she has company. My friends great dane is staying with us for the next few days. Stella is Xena's best friend and nothing makes her more happy than to snuggle up with Stella. I know that calm is key right now and fortunately Stella can snuggle with the best of them for hours on end! My dog is a happy one tonight.

yes, Xena is asleep 

happiest I've seen my puppy in 2 weeks 

Day 18:

1 guess as to which of the 4 eyes is blind due to blastomycosis ... 

Xena's 'dad' came in to town today. Both Xena and I could not be happier to have him back from Texas for the week. Still on the food roller coaster, but showing more and more signs of wanting to play -- just wears her out fast. Two minutes of jumping on dad is at least equivalent to a 60 min nap right now. Today's battle is the bathroom issue -- poor girl just can't digest anything the right way and it's taking a toll on her stomach... and my floor while I was at work ...



Day 19:

Today is the best Xena has eaten yet. Ate 1/2 a pound of a beef/lamb/blueberry dog food mix this this morning, napped, then spiked a fever this afternoon, but it broke in about an hour then she wolfed down a 1lb steak and 1/4 cup of dog food. Bathroom habits are much improved due to the quantity of food she is eating today, which is great because it really couldn't have gotten any worse from yesterday.


Day 20:

I say this with my fingers crossed that I am not jinxing Xena and myself -- but today was the 2nd day in a row that nothing new popped up but that things actually just showed improvement. I know that there will still be many ups/downs but still ... 48 hrs ... nose bleeds are gone, bathroom habits are 'normalizing', she's eaten more than her recommended food amount the past 2 days, she's showing more interest in just about everything, and breaking fevers quicker. She's still sleeping A TON (which her body needs it) and still looks like a skeleton, but the ups are outweighing the downs right now. Side note: salmon flavored cream cheese is her latest kick -- i can mix just about anything in it and she'll woof it down. :)

sleeping puppy ... it's a beauceron thing :)

1.1 lbs steak .. only 3/4s of what she ate for dinner!

<3

Day 21:

Of course ..  a new lesion. This one is small and right next to the other two. Tonight our pascalite powder came in and I'll be trying a little paste on them to help draw out the infection and close them faster!

Week 2: Fevers, Lesions & Sleep, Sleep, Sleep

Day 12: (7/19/14)

Xena's about the same as yesterday breathing wise. She's eating puppy food this morning (not her food, but food for dogs none the less). She appears bored. It's raining outside so of course all she wants to do it be outside. So we went to the farmer's market for her first outing with me since all this madness started. I figured it wound't be very crowded due to the rain and then I wouldn't have to answer as many questions about her eye, her shaved legs, or her poor scrawniness. We were only there for 15 minutes, but she did great. Wasn't out of breath at all and seemed to be excited to get out of the house for something other than to go see a vet. She's been sleeping well now. And sleeping a lot, which has to be good for her body to try to heal. The cat, Sir Lexicon, does a great job at watching over her. You can tell he missed her the last week while she was in the ICU. Tonight she didn't want to eat after we went and hung out at my friends house (she slept on her couch the whole time) but I was able to at least trick her into taking her meds! She's out cold now and hopefully dreaming of happy puppy things. 

farmers market outing (10 min tops)

the cat loves his "little" sister

DAY 13:

Xena's been doing fairly well the past 2 days. Breathing has steadied some, fevers much less drastic and less frequent, still having ups and downs with the eating, but did give her an appetite stimulant today and she's eating much better! (More like her normal self!) 

Her front left leg (really just the ankle area) has been swollen the past couple days, which isn't really new since they aspirated fluid out of it to confirm blasto. So we knew it was in her joints as well. She'd been licking at it on and off the last day or so and I just thought it was because of the hair starting to grow back on the leg might be itchy. Well, there is definitely now a small lesion (pea sized) with clear drainage. I read up on blastomycosis.ca (my hero mentors across the US that have battled through this and share their advice) about keeping them from licking it, keeping it open for air, and also doing the pascalite clay on there. 



I guess I just wasnt really thinking that she'd have any other 'new things' pop up now that we are on treatment (silly me, i should know by now that this blasto crap is not predictable).



Day 14:

I can't believe that tonight's round of medication was her 14th dose. Tomorrow is 2 weeks from when all this craziness began and 1 week from when she came home from the ICU. It feels like it was yesterday -- probably because I haven't slept well in 14 days or really done much other than concoct crazy food prep ideas to get Xena to eat and just show up for work (fortunately my patients medical issues help distract some from my dogs). Xena seems to be doing well still. I say well, but there are baby ups and downs. She sounds like she has pneumonia when she sleeps, is sneezing gross things 1-2x day, really dislikes the 2 hour time frame after her meds kick in, and I'll spare you her bathroom habits convo. On the upside she is eating chicken breast more consistently (not enough, but better), getting a lot of rest, still drinking a lot of water, and showing signs of her puppiness here and there (yesterday stuffed a treat in the sofa to hide it for later, today chased the cat around the dining room and onto the patio -- they are 15 feet apart mind you, but those 2 used to go for days chasing each other up and down the halls -- and yes, the cat also chases the dog). Oh, and her lesion from yesterday appears to be dried up and scabbed over today, so that's another win we will take. One day at a time around here. Xena's 'dad' gets into town in 4 days and I cannot wait to see him. He's been taking care of her (and me) the best he can from Texas, but man are we getting excited to see him.


Day 15: 

Well, we survived the 2 week mark from all of this. Xena;s been home for 1 week as of tonight and it feels like it was a blink of an eye ago. From what I've read we still have many more ups and downs, but today we will settle for Xena eating a normal portion of food. She managed to eat 3 cups of dog food (covered with either yogurt or cottage cheese) and 3/4 of a steak today. Tomorrow we head back to the vet to get her kidney and liver blood work checked to make sure she's doing okay on the meds. Her leg lesion burst today -- kind of gross, but as soon as it happened the swelling in that ankle went away so I know it's just her bodies way of healing.

Xena's Diagnosis & Days 1-11 of Treatment

Here's our story: ((I have to say in advance, that while reading this please know that Xena is still fighting hard and doing a little better every day although she has her ups and downs. And -- sorry for the heartbreaking photos)).

Here is the story of our 1 year old puppy and her ongoing battle against this awful blastomycosis infection.

Xena, just 1.5 weeks shy of her first birthday, started having a droop in her eyelid and a raised 3rd eyelid, called a Horner's Syndrome. This is usually benign but can also be a sign of a number of things. We took her to our amazing primary vet who did an eye exam and cleared us to just keep an eye on it. Two days later her Horner's Syndrome was gone but her eye was slightly clouded over. Again, back to the vet. Eye pressure check and a pupil scan and she's still clear with no issues. 

hazy eye

eye at its worst

Over the next 2 days her eye because so inflamed and the pressures soared to over 60mmHg (25 is normal) and this lead to the detaching of her retina. Devastated by this news, we were looking to move forward to manage the eye symptoms with the opthalmologist. Our primary vet was concerned that in a dog this young this should not have escalated so quickly and recommended once the eye was under control that we investigate any kind of auto immune related disease as the cause. 

increased pressure = detached retina

support from her bestie -- sir lexicon, the cat

One week into her eye treatment of steroids, eye drops and antibiotics her eye pressures dropped to 26mmHg. We celebrated this news and her 1st birthday. Three days later she began limping out of no where and appeared to be in no pain with palpation or stretching. I spoke to the primary vet and she suggested a neuro exam. We scheduled the appointment. With it being the July 4th holiday we would have to wait a few days. Over these few days Xena also started limping on the back left leg also. 

limping

Finally, we saw a neurologist who cleared her entirely but said her back leg was mildly tender in one spot and asked if we wanted an ortho consult. Not sure what else to do for her, I agreed to his consult and x-rays. He saw fluid around her joints on the xrays and said we could aspirate to run screens on it.  They only do procedures in the afternoon so I would have to leave her there and pick her up later (as I had to be at work from 1-4). 

I got the call from the vet specialist about an hour after I got to work. He said that we did a gram stain of the fluid and we've confirmed that she has Blastomycosis.  Blasto for short. (Not sure what blasto is? Neither did I, read the link for full details). Okay, well what does this mean? His response was along the lines of that we needed to think long and hard about the road ahead for our puppy.  That if we wanted to do treatment it would be a long and expensive road and she might not survive. Of dogs that do start treatment only 70% survive the first 10 days and that if you can make it through the meds and fight it off, then there is still a 25% chance she could relapse. 

So our options were to ignore it and have her decline (he said that within 3 weeks she would likely die from respiratory failure even though she had no labored breathing yet but that death was inevitable without treatment), admit her to the ICU and start her anti-fungal meds tonight, or let her go peacefully. Being that she's so young and an all around badass puppy we decided we had to give her a chance to fight this. I had no idea what we were up against.

 I got home the first night of her stay in the ICU and after hours of reading negative google searches on blasto I came across a message board site (blastomycosis.ca) and it completely renewed my hope that we were making the right decision  to try to fight such a terrible disease that is taking over my beautiful puppy's eye, lungs, and joints.  Armed with hope and the knowledge that our team of vets, from Xena's primary to the ophthalmologist to the neurologist to the internal medicine vets, they have all been amazing. I am fortunate enough to live 0.1 miles from the 24/7 animal hospital that treats all the severe cases in Atlanta.

Typically blasto pups present in the hospital with labored breathing. Xena had her strange eye fiasco then started limping. Below are the signs of possible blasto ... she only had two of them despite this disease taking over her entire body. 

 Lethargy
 Persistent fever of 103 degrees or more
 Anorexia
 Vomiting
 Persistent, usually non-productive cough
 Exercise intolerance
 Respiratory symptoms, fungal pneumonia
 Ocular infection, sudden blindness
 Depression
 CNS symptoms: twitches, stumbling gait, loss of coordination
 Skin ulcerations, non-healing lesions
 Lumps, nodes, swellings
 Weight loss
 Hair loss
 Lameness, fungal arthritis
 Hematuria 

Xena did well with her first few days of treatment .. it was days 4 and 5 that were the scariest. 

 right before we got to the vet on first day

 after the aspiration with her shaved legs

Night 1: She was admitted to ICU to start her meds for the 2-3 day die off period of the spores in her chest. She is on itraconazole (antifungal meds) and did a loading period where they double the medication for 3 days with along with steroids for just the 3 days to help keep the inflammation in her lungs down. When admitted she had fever, no respiratory distress, poor eye quality, limp  still in both legs. Eating great. 

Day 2: Fever roller coaster up and down all day. Eating great. Breathing great. Her fever hit 105.4 at one point and the lowest was 103.0 (normal in a dog is 100 - 102.5).

Day 3:  Fever roller coaster. Breathing faster. Her fever high was 105.2 and the lowest was 103.8. Not interested in food so I took her 2 boiled chicken breast and she ate both of them in minutes. Eye was looking a little looking better. 

Day 4: Eye better and limp completely gone. They released her to come home with instructions on breathing rate, sound and specifically if she would not lay down due to breathing. We get home and all she wants to eat was shredded cheese -- okay, whatever gets the meds down. 3 hours into being home she had tried laying on every surface to sleep. She just kept popping back up and gasping for air -- which was new. I monitored her for a while took her temp in her axilla (it was 104.6 and the vet said to they add 1.0 to the axilla reading) then decided she needed to be looked after medically. Took her back to the ER and they readmitted her and put her on oxygen. Her fever was 105.6 in the ER, her breathing was labored and her oxygen saturation levels were low, and she was hard pressed to get comfortable so they gave her a sedative in her IV line. 

The phrases that come with dealing with blasto are "it gets worse before it gets better" and "one day at a time". 

Day 5: Vet calls me at 8am to say that she's not doing great and they're concerned about if she gets worse (as she had yet to improve from the night before). Says if she does get worse we don't have any other options to save her and that her body just might not be able to handle the meds. Her temp was down to 104.9 in the AM. I went to go sit with her and she looked so awful. She would drink water, but wouldn't touch food. Her body was weak and frail and she was fighting so hard just to breath, let alone stand up. (She still was having a hard time breathing laying down). It was so upsetting. I came home so defeated and re-read every post on the blastomycosis.ca blog. The vet called and her oxygen levels dropped to 90% so they had to up her oxygen to 4%. When she was first diagnosed I was relieved that she was breathing normally and her lungs sounded great (chest x-ray was still a 'snowstorm' of spores) so I never imagined her breathing being an issue.  I rearmed myself with positive thoughts for my pup (which was not easy), some puree pumpkin, bacon and eggs and went back to visit with her. She was 10x better than when I had seen her 8 hours ago -- which mind you was still not great. Got to be with her for over 2 hours and managed to ''force feed" her the pumpkin by putting it on the roof of her mouth with a tongue depressor. Her O2  stats were still pretty crummy when she was off the oxygen for her potty break and exam, but she was FEVER FREE! 102.4! They still have her on the sedative but waited almost a full 2 hours longer than they though she would need it. It was piece of mind for me to have her sleeping laying down and soundly when I left for the night -- even it was drug inducted. 

 

<--- morning of day 5

                                   evening of day 5 --->

 More day 5 pics:

tafter her MAJOR pain meds, (she was asleep 2 minutes later)

cooler of foods for Xena

Day 6: Drastically better than day 5. This morning Xena's still fever free, ate a little bit of the eggs I left for her when offered. When I got to the hospital our primary vet was sitting with my sweet puppy keeping her company (she works for a different company but does ER rotations 1-2x a month at the hospital). Just goes to show again how fortunate we are to be were we are when this awful thing began. At noon they took her oxygen back down to 3% and her O2 stats were still 92%. I went in to visit her at lunch and brought every option of food I could think of. She ate like a champ today -- hot dog, turkey sausage dog food and lamb/rice food I got from Petco, tablespoon of peanut butter and a cup of chicken broth to wash it down. Huge change from me forcing her to eat pumpkin last night. I know we are in for many more ups and downs, but we both needed a victory today. 

day 6 

 Day 7: Today we were able to get off the oxygen! Two hours afterward her oxygen saturation was 100%. She's eating hot dogs and turkey when offered by almost anyone. Vet re-did her chest xrays and didn't see much change this morning-- it's only been 2 days since the last set. She seemed concerned that she didn't see progress that Xena may be not responding to treatment. She does have a small fever tonight after being fever free for 36 hours, but as long as she's fighting this nasty stuff I expect it to go up and down. (104 currently). Vet says if she's doing well tonight and tomorrow during the day then she might be ready to come home tomorrow night. I realize that we have many more ups and downs in the days to come, but I'm excited -- and terrified -- at the thought of at least getting my puppy home and letting her rest in her own loving space.

DAY 8: Xena is home from ICU! Her oxygen levels stayed great even though she's spiked a little bit of fever over the course of the day (104.. It seems to be coming back down -- I just took it and got 102.7 then added +1 to it since it's in the axilla -- so 103.7.) She ate more hot dog and turkey this morning and also for dinner. It's still not as much as I'd like, but it's food. She's also drinking a lot of water -- which other than her needing to go up and down a flight of stairs to go to the bathroom is great! She's trying to rest now and doing well with that it seems. Since blasto is not common in GA our team of vets are really trying to stay up to speed with this one. Today they had a round table discussion of Xena's case with the Blasto Doc from Univ of Tenn. He agreed that she's on the right meds and he told them "sometimes they just have to get worse before they can get better".  They asked us to come back in on Friday to check her vitals -- which THRILLS me that they have confidence that we will be stable from now till Friday! I know that seems silly, but I'm trying not to jump the gun and plan ahead while also trying to stay positive. Not sure any of you have met a beauceron before, but they are SUPER mood sensitive and my girl needs all the positive she can get! Today was another victory and we will arm ourselves with as many of those as we can.

at least the ICU people liked her enough to put a heart on her bag of meds

 real rest for the 1st time in days

still not herself and still struggling with normal paced breathing

Day 9: 

My younger, amazing, sister volunteered to come and puppy sit for today and the next 2 work days for me -- which takes a TON of stress off of my constant worry about Xena's breathing. Last night this 1 yr old puppy drank so much water that she had to pee every 5 minutes. (Which is great until its 12am and 2am and 4am and she can't hold it long enough to get out the door). She ate 1/2 a container of turkey lunch meat at 2am. Then this morning threw up water after our trip outside to potty. She didn't eat for the majority of the day, but did get some more meat in there at some point. It's now time for her meds and she refuses to go near anything that she thinks has pills in it now. She's too smart for her own good and I've tried everything I can think of. Our primary vet called to check on us today and recommended an appetite stimulant and called the internal med docs and got it set up for us to go pick up anytime tonight .. but I still need to get her to take her horse pills (the itraconazol is huge!) Otherwise Xena's still SUPER tired, but is panting less (still breathing rapidly but through her nose now), less drool, fever up and down still but she's starting to be able to regulate her body temp faster. What used to take 5 hours to decrease her temp now takes 1. Thankful for another day with my beautiful pupster -- now time to pull out all the stops to get these meds in her.

Day 10: She did eat better today -- probably because I've resorted to feeding her steak. She does get a mild fever 2 hours after she takes her meds every night but is sleeping it off in an hour or so still. This morning her limp was back a little, but it didn't take long for it to disappear. Her breathing has eased tremendously. She's closed mouth breathing and rarely pants unless after coming in from outside from her multiple potty breaks. It's 90 degrees here in Atlanta and humid as it gets in the dead of summer, so the house is staying at 70 and she has 2 fans blowing on her spot on the bed, as well as a water bowl on my nightstand.  

Day 11:   HOLY CRAP WE MADE IT THROUGH THE FIRST 10 DAYS

When we heard about blasto for the first time 11 days ago everything we read said the first 10 days was the hardest and roughest on the dogs body.. and it's been no picnic for Xena or us but we are here and still continue to show signs of improvement. We had a quick vitals check at the vet today. Temp was 100.5 but she's lost another 2lbs. Most cases I've read the dog looses 15-20 lbs during all of this, so right now our 7-8 aren't so terrible, but needless to say she needs to eat more. She was a healthy skinny before all of this and now she's SUPER slender.  She must have gotten the memo because without giving her the appetite stimulant she ate a cup of dog food, a small can of wet dog food, and a 4oz steak (that had her meds hiding in it). I'm exhausted, Xena's exhausted and we still have a long way to go but I'm thankful for everyday and especially the positive days. 

skinny puppy

love my puppy snuggles while I type this

To continue to read about Xena's progress, click here for the next blog post update.